INCONSISTENT ADVICE/GUIDANCE/PUBLIC MESSAGES FROM CDC: We were told to limit distribution strictly to the identified priority groups, then CDC released Public messages that no one would be turned away...Coupled with the sporadic and unpredictable deliveries of vaccine, we were left giving equally inconsistent information to the public---this has harmed our credibility with our local population and with our First Responder partners.

OUTRIGHT INCORRECT INFORMATION FROM CDC: For the May shipment of the SNS, CDC at first did not provide an inventory, and when they did so, that inventory did not match the eventual Bill of Lading that accompanied the shipment. This left us uncertain of how and where we would store these materials, since we did not know what mix of drugs and support supplies we would receive.

Actions taken to address the issue(s):

We faced this problem by providing frequent media announcements that provided as much accuracy as we could, given our own uncertainty. For the first two or three weeks, the general public seemed to accept that there would be staggered distribution, and that some persons would just have to wait, but since mid-October, the public and partners have become increasingly demanding and unwilling to accept our explanations. At our most recent clinic, we had non-priority Healthy Seniors (65yrs+)who waited in line for an hour +, despite repeated announcement about what groups would and would not be accommodated, and then either argued or outright lied about their status when they reached the Triage station.

Outcomes that resulted from actions taken:

LATE ACTION BY CDC: When the May shipment arrived, we discovered that two of the drugs (Pediatric Oral Suspension Tamiflu; and 75mg Blister-pack Tamiflu) were short-dated (the Pediatric suspension only had 30 days remaining; the Blister-pack had 6 months)---we notified our State Health Department, and presumably they notified CDC, but we did not receive Emergency Use Authorization extending the shelf life until June for the Peds. Suspension, and late October for the Blister-pack. This left us in the embarrassing position of announcing to physicians that we had drugs available as commercial supplies experienced shortages, and then being unable to meet their requests for those drugs. We do not understand why it took CDC and FDA so long to develop the EUA---They went to great lengths to describe the process at the CRI Workshop in February; certainly we were not the only LHDs to experience short-dating...We should have received EUA much, much earlier...had this been a more rapidly advancing Public Health Emergency, this delay would have virtually destroyed any effectiveness of the CRI/SNS process.

MIXED MATERIALS: Similarly, the May SNS shipment included materials we did not need or want (Surgical Gowns, Full-Face Shields) and N-95 masks from multiple manufacturers and lot numbers. When local hospitals asked us to supplement their need for masks, we discovered that the SNS shipment did not match the hospital's history for Fit-testing employees to meet OSHA requirements. We discovered the same limitation for our own personnel. Fortunately, we had pre-purchased and stockpiled a large supply of masks that WOULD match the OSHA fit-test and were able to supply the hospitals and our own needs from that separate stockpile...Meanwhile, the SNS masks sit in our storage area, unused. We learned only last week that NIOSH had issued a Cross-reference document to facilitate this problem, but we had no knowledge that such a list existed until we pointed out the problem to our CDC CRI Grant Project Officer.

Advice to other LHDs: Given the paucity of guidance from CDC, we would only suggest that other LHDs increase and intensify their pre-planning efforts, with the expectation that, in the next large or novel outbreak, we will be essentially on our own.